October 28, 2008
Transcranial magnetic stimulation approved for major depression
The FDA has reversed itself and has approved transcranial magnetic stimulation (TMS) for major depressive disorder after a first medication trial has failed. The device delivers MRI-like pulses to the brain.
A new randomized trial of 164 patients showed significant symptom improvement compared with placebo. The device will be available only at a few centers for now. It is approved only as a second-line treatment for this one indication, although it has been tested for many.
Earlier studies showed TMS to be less effective than ECT for depression, but also less invasive.
Research/Reviews
What is TMS exactly, and what has it been used for? A timely set of reviews appeared in the Canadian Journal of Psychiatry only last month.
Patient Education
Look in this category for reliable take-home information for patients who may ask about the therapeutic option.
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Depression, Psychiatry, Uncategorized | Tagged: Depression, TMS, transcranial magnetic stimulation | 
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October 21, 2008
Spiriva doesn’t slow COPD decline, but it really helps a lot anyway
Tiotropium (Spiriva) did not achieve the main study objective of lowering the rate of decline in forced expiratory volume (FEV1) among COPD patients in the large multicenter UPLIFT trial.
However, the drug was responsible for significant improvements in
* lung function,
* quality of life, and
* time to first exacerbation
Patients in the study were allowed to use any respiratory medications they wanted, except for other inhaled anticholinergic agents.
Data from the same study just prompted the FDA to lift its earlier warning about tiotropium and the risk of stroke.
Like the TORCH study reported earlier this year, the UPLIFT study came close to (but did not succeed in) finding a significant effect on mortality.
The best way to slow the rate of FEV1 decline, of course, is to quit smoking. This helps even patients with severe COPD, according to a new review in the European Respiratory Journal.
Research/Reviews
In this category, you’ll find the latest research into the predictive value of the BODE index in COPD.
Related searches
Find reports from earlier trials of interventions to slow the respiratory decline in COPD:
EUROSCOP
ISOLDE
BRONCUS
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Cardiovascular, Family Medicine, Geriatrics, Internal Medicine, Respiratory_Infectious, Uncategorized | Tagged: stroke, COPD | 
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October 21, 2008
Longitudinal study documents persistence of child bipolar to adulthood
Not only does bipolar I disorder in fact affect children (despite the skeptics), those who have it are at least 13 times as likely as others to experience the disorder as adults, according to the first major prospective study of the question. The report appears in the October Archives of General Psychiatry.
The study followed 115 children enrolled since 1995. At least half are now 18.
More than 44% continued to have manic episodes as adults, and 35% had substance use disorders. Long episode duration and daily cycling were characteristic features of the syndrome in childhood and often continued after age 18.
Young age at onset and having a mother who wasn’t very warm strongly predicted quicker relapse after recovery. Maternal warmth is a known factor from previous studies of bipolar.
Related searches
Treatment of Early Age Mania study
WASH-U-KSADS
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Bipolar, Pediatrics, Uncategorized | Tagged: bipolar disorder, mothers | 
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October 7, 2008
NIMH pulls the plug on chelation therapy trial for autism
A clinical trial of chelation therapy in autistic children with detectable blood levels of mercury has been cancelled by the NIMH.
The agency explained that a suggested link between mercury-containing vaccines and autism has not been proven.
Also, rat studies suggested that chelation therapy might be dangerous in the absence of blood lead.
No children had been enrolled in the clinical trial before it was cancelled.
All of Medicine tab
This month’s edition of Archives of Disease in Childhood compiles a recent study finding no link between the MMR vaccine and autism with letters responding to that study.
Practical Articles/News
A recent article in Psychiatric Times reviews complementary therapies for autism.
Evidence-based Medicine
Placebo worked just as well as chelation therapy in reducing distress among people concerned about the mercury in their dental fillings, according to an old randomized study found in this article category.
(The chelating drug did elute mercury, but people on placebo scored equally on anxiety and somatization measures after treatment.)
No Comments » | Adolescent, Family Medicine, Internal Medicine, Pediatrics, Psychiatry, Uncategorized | Tagged: immunization, chelation therapy, autism, vaccines, mercury, lead | Permalink
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September 30, 2008
New data explain why winter causes blues and summer lightens the mood
The amount of circulating serotonin available to the brain correlates with number of daylight hours, which should help to explain why people get the blues during the winter months.
This information comes from a new study that used improved biological methods to test healthy volunteers with no history of depression.
Daylight correlated with a reduction in regional serotonin transporter binding potential, which is related to the amount of serotonin available to the brain. Levels were higher in fall and winter for all volunteers, meaning that more serotonin was bound to the transporter and unavailable.
Then what about the evidence that suicides are most common in the spring, when there’s more daylight? A good question for further research, the authors say.
Maybe it has something to do with the sudden shift in serotonin transporter levels, or with differences in brain regionalization as they change.
Life events also affect levels of this molecule, according to previous studies.
Depression also correlates with time of sunrise, according to a 2003 study from Quebec. The author suggested manipulating daylight savings time with this in mind.
Clinical Trials
The relationship between light and depression is the subject of numerous clinical trials now underway.
Related searches
melatonin seasonal depression
light therapy SAD
photoperiod depression
Seasonal Pattern Assessment Questionnaire
Seasonal Health Questionnaire SAD
No Comments » | Depression, Psychiatry, Uncategorized | Tagged: Depression, daylight, sunshine, serotonin, seasonal affective depression | Permalink
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August 26, 2008
Substantial recurrence risk shown to follow systemic breast cancer therapy
MD Anderson researchers found a 20% recurrence risk 10 years after breast cancer patients were declared disease-free following five years of adjuvant treatment. Results of the retrospective registry study appear in the August Journal of the National Cancer Institute.
No guidelines address this situation for premenopausal women. But the range of risk would justify adjuvant or neoadjuvant therapy at the time of diagnosis, according to the authors.
Predictors of late recurrence include:
* Hormone-positive tumors not treated with endocrine therapy
* Higher stage
Very recently the same team reported on the prognostic significance of Her2 status in inflammatory breast cancer.
Practical Articles/News
The query “breast cancer anxiety” in this article category delivers a recent review of psychological factors that predict emotional distress in breast cancer patients.
Research/Reviews
Two recent reports in this article category correlate receptor subtype with location of tumor recurrence in breast cancer.
No Comments » | Breast, Cancer, Women | Tagged: adjuvant therapy, Breast, her-2, neoadjuvant therapy | Permalink
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August 19, 2008
Has reality TV spawned a new form of paranoid delusion?
A psychiatrist at New York’s Bellevue Hospital Center has been collecting cases of patients who have the delusion that their lives are a reality TV show. Because several of them identify with Jim Carrey’s character in the movie “The Truman Show”, a proposed new syndrome is named after that film.
(Looking for news from a wider range of sources than the selective SearchMedica list? Choose the option “The entire Web” just below the search box.)
The Bellevue psychiatrist in question, Joel Gold, was a coauthor of the study that documented PTSD among New York residents after the 9/ll attack.
In the high-surveillance, anti-terror era that came after, it’s no delusion that we’re being watched. But for decades psychiatrists have been reporting delusions that involve television.
Related searches
thought broadcasting
delusions virtual reality
Evidence-based Articles
What defines a new delusional syndrome? Authors from Massachusetts suggest that different delusions are more alike than unlike, in this 1999 review.
Free full text is available by clicking on “View Medline abstract on pubmed.gov” and finding the publisher’s link at the upper right of the next screen.
No Comments » | Psychiatry, Schizophrenia, Uncategorized | Tagged: delusions, paranoia, psychosis, reality TV, virtual reality | Permalink
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August 12, 2008
Meds + booze + street drugs @ home = sharp rise in accidental deaths
Fatal medical errors skyrocketed in the two decades after 1983—but not in hospitals. The increase overwhelmingly involved people who died at home after mixing medicines, street drugs, and alcohol. Death rates in this category rose 30-fold between 1983 and 2003.
Oddly, accidental deaths from any of those three substances in isolation did not increase markedly during the same period.
Don’t just blame substance abusers: At-home deaths involving medications but not street drugs or alcohol increased nearly six-fold during those two decades.
The most common victims were men between the ages of 40 and 59.
The study of death certificates is newly published in the Archives of Internal Medicine.
The increase in these deaths has been accelerating. The article urges medical professionals to address the problem by:
* assessing how well patients can manage their own medicines
* taking pains to educate them about the risks of their medications and
* keeping track of their progress
Related searches
screening alcohol use
self-report alcohol drug
Research/Reviews
What’s the best way to talk with patients about their new prescriptions? We found interesting insights with the query communication risks.
Practical Article/News
In a recent review in Psychiatric Times, a Yale University psychiatrist warns about an emerging problem among aging baby boomers: substance abuse.
No Comments » | Family Medicine, Internal Medicine, Medical ethics, Psychiatry, Uncategorized | Tagged: alcohol, drug abuse, drug interactions, medical errors, medication errors, suicide | Permalink
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August 12, 2008
Cell phones and cancer: News from Pittsburgh, or just lots of noise?
What should we make of the new controversy about cell phones and brain cancer? The flap arose after the director of an NCI-designated cancer center in Pittsburgh warned employees to limit their use of cell phones to avoid the risk of cancer.
Oncologists elsewhere have objected that there is no solid evidence of a risk. But the source of the alarm, cancer immunologist Ronald B. Herberman, does have a prestigious research record in his field.
There is no consistent evidence of an increase in risk for glioma, meningioma, or acoustic neuroma, according to case-control studies in Europe that have yet to be completely published.
The weight of existing evidence shows no link with brain tumors, according to a meta-analysis published this year. All the reports call for further studies, because the ones to date have flaws.
To access full text from a PubMed result, click on “View Medline abstract on Pubmed.gov” at the bottom of the abstract. Next, click the publisher’s link at upper right.
This episode might cause headaches for anyone who owns a cellphone. But the phone itself probably isn’t the actual source of anyone’s headaches, according to a recent British study.
Research/Reviews
Easily find the existing studies into the question of cell phones and brain cancer here.
Mental /Nervous System tab
Setting aside the risk of tumors, what are the known effects of mobile phone use on the brain?
No Comments » | Brain, Cancer, Uncategorized | Permalink
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